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General NPI Number Information
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NPI Number | 1073243549
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Entity Type | Individual
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Provider Name | CASEY E JACOBS-CAMPBELL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/16/2022
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Last Update Date | 06/16/2022
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Provider Practice Location Address
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Address Line | 1801 N 6TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47804-4086
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Country | US
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Telephone | 812-238-4708
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Fax |
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Provider Business Mailing Address
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Address Line | 21 BARTON AVE
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City | TERRE HAUTE
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State | IN
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Zip | 47803-1835
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Country | US
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Telephone | 812-241-2853
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 1396182788
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License Number State | IN
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